Objective: To determine whether the ear tips of dedicated stethoscopes (DS) that are used on patients prescribed contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enteroc...
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Objective: To determine whether the ear tips of dedicated stethoscopes (DS) that are used on patients prescribed contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, or multiple antibiotic-resistant Acinetobacter baumannii become contaminated with these micro-organisms. Design: Culture of DS ear tips. Setting: A 524-bed tertiary care university hospital. Methods: DS ear tips were inoculated directly onto bacteriologic media and incubated for 48 to 72 hours. Growth of more than 10 colonies from the 2 ear tips collectively was indicative of contamination. Results: Ear tips of 78 DS from 69 patients were cultured. Ear tips from 17 % (13/78) of the DS were contaminated with potentially pathogenic bacteria: 2 with S aureus (1 MRSA), 1 with E faecalis, 7 with Acinetobacter species, 2 with Pseudomonas species, 1 with Escherichia coli, and 1 with Moraxella. None of the stethoscope ear tips was contaminated with the same pathogen for which the patient was prescribed contact precautions (95 % CI, 0-3.8 %). Conclusion: Although the ear tips of DS from patients who were prescribed contact precautions for MRSA, vancomycin-resistant E faecium, or multiple antibiotic-resistant A baumannii were not contaminated with the indicated nosocomial pathogen, 94 % of the evaluable ear tips were contaminated, including with MRSA (1.3 %) and Acinetobacter (11 %). Regular disinfection of ear tips of DS between users should be considered.
Background: Highly resistant (HR) Acinetobacter baumannii (AB) are frequently hospital-acquired and may be important causes of severe nosocomial infections. Objective: Determine risk factors associated with such colon...
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Background: Highly resistant (HR) Acinetobacter baumannii (AB) are frequently hospital-acquired and may be important causes of severe nosocomial infections. Objective: Determine risk factors associated with such colonization/infection. Method: Retrospective review in 2000 of all AB isolates from sterile (blood, cerebrospinal fluid [CSF]) and nonsterile (respiratory, urine, and miscellaneous) sites. HR was defined as resistance to amikacin and/or imipenem and/or ampicillin-sulbactam. Isolates were analyzed as representing infection or colonization. A database including prior hospitalization, prior antibiotic use, nursing home residency, and procedures undergone was compiled. Results: One hundred twenty-two cases of AB were identified. Eighty-four met the definition of HR;6 (4.9%) were completely resistant to all antibiotics. Four (4.7%) isolates were from sterile body sites (3 blood, 1 CSF);43 (51.2%) were from respiratory sites;20 (23.8%) were from urinary sites;and 17 (20.2%) were from "other" sites. Only 4 (20%) of the urinary, 6 (35.2%) of the miscellaneous, and 23 (53.4%) of the respiratory isolates were deemed true pathogens;all blood/CSF isolates were considered pathogens. Associated risk factors included prior antibiotic usage (71%);prior hospitalization (24%);prior nursing home residency (34%);ventilator use (77%);tracheostomy placement (56%);and Foley catheterization (85%). Twenty-seven (63%) of 43 respiratory, 8 (40%) of 20 urinary, and 6 (35%) of 17 "other" body isolates were treated. Outcome was not statistically significant in treated versus untreated patients. All patients with CSF/blood isolates underwent successful microbiologic eradication with 50% survival. The overall mortality rate was 10%. Conclusion: Antibiotics, Foley catheters, and tracheostomy/ventilator usage were strongly associated with AB isolation. Prior hospitalization and nursing home residency were less common risk factors. Outcome was not different in treated versus untreated patien
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